Endoscopic bronchial occlusion for postoperative persistent bronchopleural fistula with computed tomography fluoroscopy guidance and virtual bronchoscopic navigation

Abstract

Rationale:The development of postoperative bronchopleural fistula (BPF) remains a challenge in thoracic surgery. We herein report a case of BPF successfully treated with endoscopic bronchial occlusion under computed tomography (CT) fluoroscopy and virtual bronchoscopic navigation (VBN).Patient concerns:A 63-year-old man underwent right upper lobectomy with concomitant S6a subsegmentectomy for lung adenocarcinoma. On postoperative day 24, he complained of shaking chills with high fever.Diagnoses:BPF with subsequent pneumonia and empyema.Interventions:Despite aggressive surgical interventions for the BPF, air leakage persisted postoperatively. On days 26 and 34 after the final operation, endobronchial occlusions were performed under CT fluoroscopy and VBN.Outcomes:The air leaks greatly decreased and the patient was discharged.Lessons:CT fluoroscopy and VBN can be useful techniques for endobronchial occlusion in the treatment of BPF.

Bronchosubcutaneous fistula manifesting as massive subcutaneous emphysema treated successfully by endobronchial Watanabe spigots

“…An EWS is a bronchial spigot made of silicon used to treat various disorders related to bronchial or pulmonary fistulae [3]. Besides EWSs, endobronchial occlusion can also be achieved by cyanoacrylate, a polymer glue sealant, or endobronchial valves [4,5]. In our patient, the diameter of target subsegmental bronchi was relatively large (6 mm).…”

“…VBN contributed greatly to the success of our procedure in two ways. The first was accurate localization of the bronchi responsible for the BFs [5]. Conventionally, determination of affected bronchi necessitates the balloon occlusion test [3].…”

“…As bronchial occlusion was a well‐known treatment for bronchopleural fistula [3–5], the management of a BF with EWS was an extension of current practice. Although we were unsure that SE could be treated with bronchial occlusion only, SE improved dramatically without surgical intervention.…”

“…On the basis of the VBN image, we obtained a vivid image of the route to the target bronchi. VBN demonstrates the virtual endobronchial view of the airway non‐invasively, and facilitates the endobronchial procedure effectively [5].…”